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Chiropractors Push to Reverse New York’s Workers’ Comp Guidelines

New York chiropractors don’t like the new medical treatment guidelines adopted last December by the New York State Workers’ Compensation Board. These changes focus on the treatment for the mid- and low-back, neck, shoulder and knees. The state’s main chiropractic association is lobbying state lawmakers to reverse the new guidelines.

New York State Chiropractic Association President Bruce Silber told Insurance Journal that the guidelines mostly affect chiropractors and physical therapists. “But really, there was no input from these providers” when the workers’ comp board developed these rules, he said. These rules jeopardize insurance for thousands of workers and retirees, he argued.

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“They allow two-to-three months to get better. But in the event that people need longer treatments, there is now a great difficulty in getting additional treatments,” Silber said. “In the past, those with a chronic condition were allowed periodic treatments. But now, if you have a chronic, permanent problem, and if it’s not gonna’ get completely resolved, you cannot get a treatment.”

He said California, a state that had adopted similar guidelines, saw its overall cost of care go up. “They said it would reduce the cost of care but it actually went up because people now turn to more costly drugs and surgeries.”

Silber and New York State Chiropractic Association have been lobbying New York State legislators to address their concern. The State Assembly successfully passed a bill earlier this year that would have reversed the change, but it never came to a vote in the State Senate. Silber said lawmakers would reintroduce a similar measure in a future session

Objective Functional Improvement

But New York State Workers’ Compensation Board spokesman Brian Keegan defended the board’s guidelines. He told Insurance Journal that injured workers now receive care pursuant to clear, objective guidelines that are structured to produce improved medical outcomes. They establish “an evidence-based standard of care” that look for “objective functional improvement.”

“If a provider wants to continue care beyond the timeframes outlined in the guidelines, they must simply supply evidence that the care is necessary and is benefiting the patient,” Keegan said.

To date, medical providers have filed 78,178 valid variance requests and more than two-thirds of them were approved immediately by either the insurance carrier or the board, according to Keegan. “No requested service is denied if the provider can show objective evidence that a treatment medically benefits their patient,” he said.

The spokesman took issue with criticism from New York State Chiropractic Association. He said that especially for chiropractic care, the guidelines’ standard of looking for objective functional improvement is ‘exactly the same’ as that recommended by a recent consensus report of chiropractors published in their own journal, the Journal of Manipulative and Physiological Therapeutics.

The Business Council of New York State, a business organization, supports the new medical guidelines. “The Business Council supports evidence-based medicine and a system where the merits of the treatment matter,” said Communications Director Robert Lillpopp. He said New York was one of the last states to adopt impartial medical treatment guidelines, which reflect medical consensus on appropriate and effective care for injured workers.

“These guidelines were developed by a team of medical professionals. The AFL-CIO and The Business Council both supported this approach to ensure injured workers receive medical treatment backed up by solid medical evidence on its effectiveness,” Lillpopp said.

The Business Council charged that a legislative effort to reverse these guidelines is “being pushed largely by a single sector of medical providers — chiropractors — whose services and income are now subject to evidence-based limits for major categories of injuries.”

Paintball Ruptures Woman’s Breast Implant; Injuries Cause Thousands of ER Visits

By MIKAELA CONLEY
Sept. 1, 2011

A British woman’s silicone breast implant ruptured after she was shot in the chest during a paintball game, throwing a spotlight onto the potential dangers of a hobby that attracts millions.

“Due to an incident at our Croydon Paintballing centre … we respectfully ask that any ladies with surgical breast implants notify our team at the time of booking,” UK Paintball wrote in a statement after the incident, which happened in Croydon, a town in south London.

“You will be given special information on the dangers of paintballing with enhanced boobs and asked to sign a disclaimer,” the statement continued. “You will also be issued with extra padding to protect your implants while paintballing.”

Symptoms of a ruptured implant include burning or tingling in the affected breast, lumps around the implant or armpit, change in breast size, and softening or hardening of the breast.

Staff at UK Paintball confirmed with the BBC that the woman is expected to make a full recovery.

About 10 million Americans participate in paintball activities, and many more worldwide, according to a new U.S. report. In 2008, more than 20,000 emergency department visits were related to injuries caused by air guns, including paintball guns and BB guns, according to the study.

The data, published by the U.S. Department of Health & Human Service’s Agency for Healthcare Research and Quality, found that hospitals around the country saw an average of 56 visits associated with these guns each day. Males were five times more likely to visit the hospital for the injuries than females.

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“We saw a strong demographic association,” said Ryan Mutter, senior economist at AHRQ and lead author of the study. “Most people were male, young, poorer, Southern and rural.”

“As an urban ED, we see very little of these injuries,” Dr. Carl Ramsay, chairman of emergency medicine at Lenox Hill Hospital in New York, wrote in an e-mail. “In my previous experience in more rural areas, as reflected in this report, these injuries were commonplace.”

Children 17 and younger made up most of the documented visits for paintball and air gun wounds, and the majority of injuries consisted of open wounds on the arms, legs, head and neck. About 4 percent of the visits related to eye disorders.

Chris Fermoselle, manager of NYC Paintball, said eye injuries are the biggest concern on a paintball field.

“Basically, our safety is all about wearing your mask,” said Fermoselle. “Safety is number one on any paintball field, and we’re always enforcing keeping the mask on even if you get shot or paint is all over it.”

Players are not required to wear chest and back padding, although it is available, free of charge, for women and children at the facility. Men must pay $6 for the added cushion.

Fermoselle noted that most players will just wear a couple layers of clothing to protect from the pelts. While the game can leave players bruised and battered sometimes, he said he was surprised by the report’s findings because the facility has only been host to about 20 injuries since it opened seven years ago. All players must sign a waiver noting the risk of injury and death while playing.

But experts noted that the number of injuries is likely higher than in the report because not everyone who’s hurt visits the emergency room.

“The data is impressive but certainly reflects only those who … decide to seek care,” said Ramsay. “Many other injuries occur in a subset of patients who, for a variety of reasons [among them: legal, lack of insurance, parental scrutiny] do not seek medical attention and thus are not reported in these statistics.”

“While gun safety classes rarely are utilized for air guns in particular, they certainly would contribute to a reduction of injuries,” continued Ramsay. “Proper protective clothing, head and eye gear would also significantly reduce the severity of many of these injuries.”

College Athlete Died of Head Trauma, Father Says

A 22-year-old football player for Frostburg State University in Maryland has died from head traumasustained on the field, his father said.

Frostburg State University

Derek Sheely, a football player at Frostburg State University in Maryland, died on Sunday, nearly a week after passing out during a routine practice.

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Nearly a week after passing out during a routine practice, fullback Derek Sheely died late Sunday at the University of Maryland R Adams Cowley Shock Trauma Center in Baltimore.

Kenneth Sheely, Derek’s father, said in a telephone interview from the family’s home in Germantown, Md., that he was told by doctors that Derek had sustained “severe head trauma.”

Kenneth Sheely added: “I don’t know how it happened. It doesn’t really matter how it happened, personally. It’s not going to change the situation with Derek. But I want to let it be known that he didn’t have some kind of heart condition or other kind of condition. It was severe head trauma.”

Liz Medcalf, a spokeswoman for Frostburg State, said Sheely had been participating in “regular drills” with his teammates Aug. 22 when he began feeling woozy. He was being helped off the field when he collapsed.

Kenneth Sheely said his son did not have any documented concussions or other head injuries that he was aware of, and he did not know if the death was a result of one or multiple blows to the head.

Two to five high school football players die each fall as a direct result of on-field brain injuries, but such deaths are rare among college players, according to research by the University of North Carolina National Center for Catastrophic Sport Injury Research. Teenagers are known to be more susceptible to having multiple hits to the head result in brain bleeds and massive swelling, a condition known as second impact syndrome, in large part because the brain tissue has not yet fully developed.

“There have been some older boxers who die from multiple blows leading to vascular engorgement,” said Dr. Robert Cantu, a neurosurgeon in the Boston area who is the medical director of the North Carolina research group and a recognized expert in athletic brain injuries.

“But the overwhelming majority of the world’s classic second-impact-syndrome cases are people 18 and younger,” Cantu said.

Given the rarity of second-impact syndrome among players of Sheely’s age, a different cause of death could be identified as facts of his case emerge.

Sheely was first taken to the emergency room at Western Maryland Regional Medical Center in nearby Cumberland and was later transferred to the shock trauma center in Baltimore when the severity of the injury was recognized. He was listed in critical but stable condition last Wednesday after multiple operations, according to hospital officials. But the pressure in his brain from swelling could not be alleviated.

“From my experience, the trauma team in Baltimore seemed to be outstanding; they did everything possible,” Kenneth Sheely said. “My son was a fighter, and he didn’t give up on any challenges. He had a very strong heart and a very strong will. And he fought as hard as he could against this head injury and we did everything we could, but ultimately the head trauma was too severe and the pressure couldn’t be controlled.”

The Sheely family notified university officials of the death in an e-mail late Sunday.

“Derek was a senior history and political science major, a student-athlete, a fullback on the Bobcat football team and a truly exemplary human being,” Jonathan Gibralter, the university president, said in an e-mail statement. Coach Tom Rogish, Gibralter continued, “told me that Derek was one student he never had to worry much about because he excelled both in the classroom and on the football field.”

Sheely transferred from Penn State after one year to play football at Frostburg State, a Division III program. He was named to the Atlantic Central Football Conference all-academic team in 2010. He was an honors student and was named a team captain for the coming season.

“My son was incredibly healthy,” Kenneth Sheely said. “He trained all summer. This was his senior year; this was going to be his last opportunity to play football. He was passionate about it. He drove himself to try and be as good as can be.

“We’re not blaming anybody; that isn’t our mission right now. But hopefully, somebody does make sure that if there’s a lesson to be learned and it can help protect somebody else, then that should be done. I wouldn’t want my son to just die in vain, and if something can be made better, through education or equipment or whatever it is, that would be helpful.”

Alan Schwarz contributed reporting.

Quiet Changes To New York Workers Comp Rules Leave Out Those With Chronic Pain

A little-noticed policy change at the state Workers’ Compensation Board is jeopardizing insurance for thousands of workers and retirees with long-term medical problems.

scaffold collapse.jpgOur Glenn Blain reports:

New treatment guidelines quietly enacted by the board late last year limit coverage to therapies that yield “functional improvement” in patients – leaving out people with chronic pain conditions, say labor leaders and caregivers.

“They basically tried to throw out all injured workers with chronic conditions,” said Bruce Silber, president of the New York State Chiropractic Association, which has been lobbying lawmakers to intervene.

“They give them approximately two to three months to get better.”

The board has applied the guidelines to new cases and existing patients in the system, including those who had been receiving treatment for years, Silber added.

“It’s a travesty,” said Jim Beamish, a retired Verizon worker from Massapequa Park, L.I., whose chiropractor dropped him after 13 years of treatment because of the new policy.

“They just make you feel like you are almost a criminal to try and get care,” added Beamish, who still suffers neck pain from a 1998 fall.

Workers’ Compensation Board officials and members of the state Business Council – which supported the changes – defended the new policy as an”evidence-based” system that ensures workers receive care quickly.

“In the past, there was no objective and consistent standard for determining whether the care was effective, which can lead to potential fraud, delay and mismanagement of the system,” said board spokesman Brian Keegan.

Keegan said people denied coverage can appeal for a variance so long as they can show “objective evidence that a treatment medically benefits their patient.”

Keegan said 78,178 variance requests have been filed, and more than two-thirds were approved.

Critics, including the powerful AFL-CIO, said the variance process is cumbersome and difficult to navigate.

“The agency now views itself asthe protector of insurers and employers,” said Robert Grey, a lawyer who specializes in workers’ compensation cases. “Clearly, someone thinks cutting off medical treatment will save money for employers and insurance companies.”

Legislation that would have stopped the board from applying its new guidelines retroactively was approved by the Assembly this spring but stalled in the GOP-controlled Senate.

The bill faced stiff opposition from the Business Council.

“You just don’t do something forever just because you feel like it,” said the Business Council’s Maggie Moree. “You have to have evidence.”

Upstate Republican Sen. George Maziarz, the bill’s sponsor, said he’s pressing to have the Senate take up the measure at a yet-to-be-called session this fall – or in January.

“People are being denied care that is inexpensive and that I think helps them,” Maziarz said.

Average Auto Insurance Prices Saw No Change between June and July

2011-08-30 08:58:54 (GMT) (WiredPRNews.com – Auto News, Press Releases, insurance)

Washington, DC (WiredPRNews.com) The average cost of a car insurance policy in the United States remained stagnant between June and July, according to the Bureau of Labor Statistics (BLS).

The BLS indicated in its latest report on consumer prices that the cost of all items rose by a mere one-tenth of 1 percent between the two months, while car coverage costs saw zero percent change.

Data included in the BLS’s July Consumer Price Index (CPI) report show that policy prices in July 2011 were about 3.3 percent higher than in July 2010.

Source: http://bls.gov/cpi/cpid1107.pdf

That represents a pretty small change for all insurers over the course of a year, but rates at some companies may have changed more than others, and reevaluating coverage options may still be a good idea in order to maximize savings. Finding cheap auto insurance for teenagers and other high-risk groups, though, is still likely to be difficult.

Vehicle insurance prices have remained pretty flat overall in 2011. The largest month-to-month increase was only one-third of 1 percent.

The prices evaluated for the CPI are based on hundreds of sample driver profiles spread out across the country. The driver info and coverage options are not changed over time, so the rates only fluctuate when insurers adjust their pricing structures or issue dividends to policyholders.

So even though the average prices in the CPI show upward or downward price trends, average Americans may actually be paying larger or smaller amounts on policies depending on changes in their own driver and coverage profiles.

To learn more about this and other insurance issues, readers can go to http://www.onlineautoinsurance.com/teenagers/ where they will find informative resource pages and a quote-comparison generator that can help shoppers efficiently evaluate their coverage options.

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